A messaging strategy to promote Ebola treatment-seeking behaviour in Sierra Leone
This study developed a set of Ebola messages based on the findings of qualitative research conducted in ‘hotspot’ areas of rural and urban Sierra Leone. The messages respond directly to community concerns about various aspects of the Ebola response and about Ebola itself.
Over the course of the West African Ebola epidemic, many people have avoided going for treatment. One reason for this has been a lack of trust in the health system, and, with sick people being cared for at home, the result has been the continued spread of the virus through the community. This project took an applied anthropological approach to developing messages designed to encourage people in Sierra Leone, who think that they or members of their family may have Ebola, to go for treatment.
The starting point in this applied anthropological study has been that the voice of the Sierra Leonean people should be heard in the development of messages to promote Ebola treatment-seeking behaviour in the country. Qualitative work was conducted in two ‘hotspot’ areas of the country, one in urban Freetown and the other in rural Bombali district in order to identify issues of concern within the community, and to form the basis for messages that would address these concerns.
The three-month project, which ran between January 15 and April 15 2015, was conducted by a consortium including the Epidemiology and Global Health Unit, Umeå University, Sweden; the Medical Research Centre (MRC), Sierra Leone; and the Centre for Health and Research Training, Sierra Leone (CHaRT-SL). Financial support was provided by Research for Health in Humanitarian Crises (R2HC), as part of their £8 million Emergency Ebola Health Research Call, funded equally by the Wellcome Trust and DFID – we received £158,000. R2HC is managed by Enhanced Learning and Research for Humanitarian Assistance (ELRHA).
The project’s first activity was a kick-off meeting in Freetown, attended by stakeholders from the Ministry of Health and Sanitation, the National Ebola Response Centre, and the US Centres for Disease Control. Formative research was then conducted in the two study areas, including a series of 16 Focus Group Discussions with ‘ordinary’ people, and 24 in-depth interviews with health workers and community leaders of various sorts. Based on this rich dataset, a draft set of messages was produced at a 5-day workshop in Freetown, with participants from all three consortium partners, who collectively have expertise in communications, Sierra Leonean culture and politics, and appropriate methodological skills. The formative research had made clear the importance of having messages disseminated in the flesh by people who are known and trusted, and so we emphasised such community-oriented messengers and channels in the draft messaging.
Field-testing of the draft messages was then undertaken, in the same study areas as the initial formative research, and in some cases using the same people: 8 focus group discussions were held, with the groups stratified by age and sex. Based on this feedback, we were able to fine-tune the messages, and produce a final document which included 14 core topic areas. Six of these were deemed to be of particular importance, and these were therefore designated as priority topics, to be used either more intensively than, or prior to the others. The topic areas were as follows:
• Topic 1, Burial teams and respect (Priority topic) • Topic 2, Burial teams and bribery (Priority topic) • Topic 3, Fear of ambulances (Priority topic) • Topic 4, Misconception, killing of patients (Priority topic) • Topic 5, Distrust of health system (Priority topic) • Topic 6, Fear of chlorine (Priority topic) • Topic 7, Stigma against survivors • Topic 8, Stigma against Ebola workers • Topic 9, Get early treatment • Topic 10, Call 117 • Topic 11, Caring for the sick while waiting for ambulance • Topic 12, Staying safe while waiting for burial team • Topic 13, Ebola denial • Topic 14, 117 prank calls
The dissemination process has been greatly facilitated by our active engagement with key national level stakeholders throughout the process. Relevant authorities were kept informed throughout the study, both through attendance at our workshops and via presentations at the National Ebola Response Centre’s Daily Briefings. We were fortunate to have the Deputy Minister of Health present at our final dissemination meeting, alongside senior representatives from various UN agencies and non-governmental organisations. The package of messages has been taken up and is contributing to the final push to bring this devastating epidemic to an end.